Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2019; 16 (2): 81-160 ➤ Целесообразность (правомочность) перевязки непарной вены (vena azygos) при выполнении двунаправленного кавопульмонального анастомоза при этапной коррекции врожденных пороков сердца с одножелудочковой гемодинамикой

Expediency (competence) of vena azygos ligation when performing a bidirectional cavopulmonary anastomosis, with a staged correction of congenital heart defects with one-ventricular hemodynamics

Authors: L.A. Bockeria 1, E.S. Nikitin 1, I.A. Yurlov 1, D.V. Kovalev 1, M.A. Murzov 1, I.M. Makrushin 2

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2019-16-2-94-103

UDC: 616.12-007-053.1:616.124-007.2]-089.86

Link: Clinical Physiology of Blood Circulaiton. 2019; 16 (2): 94-103

Quote as: Bockeria L.A., Nikitin E.S., Yurlov I.A., Kovalev D.V., Murzov M.A., Makrushin I.M. Expediency (competence) of vena azygos ligation when performing a bidirectional cavopulmonary anastomosis, with a staged correction of congenital heart defects with one-ventricular hemodynamics. Clinical Physiology of Circulation. 2019; 16 (2): 94–103 (in Russ.). DOI: 10.24022/1814-6910-2019-16-2-94-103

Keywords:  1 Bakoulev National Medical Research Center for Cardiovascular Surgery Ministry of Health of the Russian Federation Rublevskoe shosse 135 Moscow 121552 Russian Federation
2 Pirogov Russian National Research Medical University Ministry of Health of the Russian Federation ul. Ostrovityanova 1 Moscow 117997 Russian Federation

Received / Accepted:  March 29, 2019 / April 1, 2019

Full text:  

Abstract

Objective — the rationale for the exclusion of azigos vein ligation during the stage of performing cavopulmonary anastomosis in patients with congenital heart defects and single ventricular hemodynamics.

Material and methods. The basis of this study was made by materials of clinical observations of 12 patients, conducted in the nearest postoperative period after surgery on the open heart for the period from 2011 to 2016. All 12 patients in the near postoperative period suffered from severe transudation into the pleural and abdominal cavities. The mean age of patients was 7.58±0.85 years, the average height was 119.3±7.92 cm, the average weight was 23.86±4.35 kg. Female patients were 8, male — 4. The main nosological characteristics of the patients included several different diagnoses: a double distal vascular from the right ventricle (4 patients), tricuspid valve atresia (2 patients), a single ventricle (4 patients), transposition of the main vessels with right ventricular hypoplasia (1 patient), general form atrioventricular communication with pulmonary artery stenosis (1 patient).

Initially, the mean pressure in the pulmonary artery was 14.8±1.46 mm Hg, and the total pulmonary resistance 1.89±0.07 units. Three patients underwent fenestration between the extracardiac conduit and the right atrium. All patients underwent EchoCG study in dynamics. According to ultrasound, the final diastolic volume of the functionally single ventricle and the final systolic volume of the functionally single ventricle, the ejection fraction of the functionally single ventricle, the impact volume were determined. To determine the parameters of central hemodynamics used the generally accepted formulas.

Results. Despite the fact that the level of central venous pressure for 5 days ranged from 14.33±0.96 to 15.33±1.33 mm Hg the level of transudation from the pleural and abdominal cavities was extremely high and was in the range from 1241.67±267.59 to 2470.8±391.2 ml per day. In this case, the indexed final diastolic volume of the functionally single ventricle gradually decreased from 70.63±10.22 ml/m2 on the first day to 51.25±7.47 ml/m2 by the fifth day, and the indexed stroke volume of the functionally single ventricle decreased from 43.7±7.07 to 29.05±4.27 ml/m2. At the same time, the ejection fraction of the functionally single ventricle fluctuated within 56%.

Conclusion. Our data and our analysis suggest that ligation of the azigos vein during the first stage — the formation of a bidirectional cavopulmonary anastomosis of the non-cessobrase and is fraught with serious complications associated with impaired adequate venous outflow from both the mediastinal organs and the central nervous system. This procedure can lead to the development of postcapillary venous hypertension and, as a consequence, to endothelial dysfunction, as well as to the restructuring of the pulmonary veins vascular bed, including pulmonary vein remodeling (narrowing).

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About Authors

  • Leo A. Bockeria, Dr. Med. Sc., Professor, Academician of RAS and RAMS, Director; ORCID

  • Evgeniy S. Nikitin, Dr. Med. Sc., Head of Intensive Care Unit for Older Children with Congenital Heart Disease

  • Ivan A. Yurlov, Cand. Med. Sc., Surgeon; ORCID

  • Dmitriy V. Kovalev, Dr. Med. Sc., Leading Researcher; ORCID

  • Mikhail A. Murzov, Doctor of Intensive Care Unit

  • Igor’ M. Makrushin, Cand. Med. Sc., Associate Professor of Outpatient and Emergency Pediatrics; ORCID


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